BMJ No 7142 Volume 316
Press Releases Saturday 9 May 1998
TRAVEL TO SCHOOL: RICH CHILDREN
RIDE - POOR CHILDREN WALK
SECONDARY PREVENTION OF HEART DISEASE
SHOULD BE IMPROVED
MEASURES TO PREVENT ACCIDENTAL CHILD
POISONING
POVERTY IS NUMBER ONE HEALTH PROBLEM
PAEDIATRICIANS NEED GOOD WORKING KNOWLEDGE OF TROPICAL INFECTIONS
TRAVEL TO SCHOOL: RICH CHILDREN RIDE -
POOR CHILDREN WALK
(Determinants of car travel on daily journeys to school: cross
sectional
survey of primary school children)
http://www.bmj.com/cgi/content/full/316/7142/1426
In this week's BMJ a study conducted in primary schools in the
inner London
boroughs of Camden and Islington by DiGuiseppi et al from the
Institute of
Child Health analysed the methods of transport used for the daily
journeys
to school. They found that whilst most children (69 per
cent) walked to
school, 26 per cent travelled by car. Attendance at a
private school,
family car ownership and longer distances to travel to school
were the
principal determinants of car travel.
Nine out of ten parents confessed to being worried about their
child being
abducted or hit by a car. Most children (61 per cent) were
rarely or never
allowed out without an adult.
DiGuiseppi et al conclude that policies to encourage children
to attend
nearby schools (to reduce car travel) and that address parental
fears,
could increase the number of children walking to school and
reduce traffic
congestion.
The annual distance walked by children has fallen by nearly
one third (28
per cent) since 1972. Increased car use has been linked
with obesity,
adverse health effects in later life, limitations on children's
independence, traffic congestion and pollution.
Contact:
Dr Carolyn DiGuiseppi, Senior Research Fellow, Child Health
Monitoring
Unit, Department of Epidemiology and Public Health, Institute of
Child
Health, University College London Medical School, London
C.DiGuiseppi{at}ich.ucl.ac.uk
or
Dr Ian Roberts, Department of Epidemiology, Institute of Child
Health
SECONDARY PREVENTION OF HEART DISEASE SHOULD
BE IMPROVED
(Secondary prevention in coronary heart disease: baseline
survey of
provision in general practice)
http://www.bmj.com/cgi/content/full/316/7142/1430
(Secondary prevention clinics for coronary heart disease:
randomised trial
of effect on health)
http://www.bmj.com/cgi/content/full/316/7142/1434
In two General Practice papers in this week's BMJ, Dr Neil
Campbell et al
from the University of Aberdeen find that secondary prevention
for coronary
heart disease could be improved within general practice and that
where
clinics to promote secondary prevention have been set up, the
health of
patients has improved.
In their study undertaken in the Grampian region, the authors
found that
half of patients in general practice with coronary heart disease
had missed
at least two opportunities for effective medical treatment, such
as
prescribing Beta blockers or aspirin. They also discovered
that nearly two
thirds of patients had two or more high risk lifestyle factors
that would
benefit from change, such as exercising, giving up smoking or
eating a
better diet.
The authors also found that practices which ran nurse led
clinics to
promote secondary prevention had healthier patients at the end of
their one
year study, with less chest pain and a reduction in hospital
admissions.
Campbell et al conclude that even though there are known
benefits in
implementing secondary care to patients with coronary heart
disease, there
seems to be plenty of opportunity for improving procedures within
general
practice.
Contact:
Dr Neil Campbell, Clinical Research Fellow, Department of General
Practice
and Primary Care, University of Aberdeen Fosterhill Health
Centre, Aberdeen
n.campbell{at}abdn.ac.uk
MEASURES TO PREVENT ACCIDENTAL CHILD POISONING
(Child resistant packaging should be used on all over the
counter drugs)
http://www.bmj.com/cgi/content/full/316/7142/1460
(Child resistant packaging should be legal requirement)
http://www.bmj.com/cgi/content/full/316/7142/1460
(Manufacturer's reply)
http://www.bmj.com/cgi/content/full/316/7142/1460
Three letters in this week's BMJ address the issue of
accidental child
poisoning. In response to two letters citing Tixylix
cough mixture as a
particular problem, the manufacturer, Novartis Consumer Health,
states that
this product is soon to be packaged in a child resistant
container, but
also offers advice about how accidental poisoning can be
avoided. They
state that it is important for parents to store medicines well
out of the
reach of children (preferably in a locked cupboard). They
also suggest
that it is important to minimise the child's exposure to the
container,
opening and pouring measures whilst the child is out of sight and
ensuring
that the cap is firmly replaced after use. Novartis
notes that most
reports of misuse occured with medicines in child resistant
packaging.
Both Clive Newman and colleagues from Queen's Medical Centre
at the
University Hospital in Nottingham and John O Donnell et al from
the Royal
Hospital for Sick Children in Edinburgh conclude that the only
way to
ensure that all liquid medicines are supplied in child resistant
containers
would be to introduce appropriate legislation.
Contact:
John O Donnell, Specialist Registrar in Accident and Emergency
Medicine, St
John's Hospital, Livingstone, Edinburgh
Clive Newman, Senior Pharmacist, Queen's Medical Centre,
University
Hospital, Nottingham
David S Kettle, Director of Regulatory and Medical Affairs,
Novartis
Consumer Health, Horsham, West Sussex
POVERTY IS NUMBER ONE HEALTH PROBLEM
(How the cycle of poverty and ill health can be broken)
http://www.bmj.com/cgi/content/full/316/7142/1456
In a letter published in this week's BMJ, Professor Rodrigo
Guerrero et al
cite the number one health problem in the world as poverty and
say that
the world can no longer deal with health whilst ignoring
it. The authors
note that the number of people living in absolute poverty has
more than
doubled since 1975 and stands at 1.3 billion, of which seven out
of ten are
women.
Guerrero et al are convinced that a new approach to poverty
and health is
required and that doctors and health professionals cannot do it
alone.
They believe that basic health care and basic education for all
are vital
and that the poorest groups of the population must have access to
them.
This means making funding at community and district levels a
priority -
development from the bottom upwards, with the active
participation of poor
people, has proved to be the best and most sustainable
approach. They
conclude by saying that health is the responsibility of society
as a whole
and not merely that of the medical establishment and that public
health
must no longer be looked on as a secondary beneficiary of
economic
prosperity.
Contact:
Professor Andrew Haines, Professor of Primary Care, Royal Free
and
University College London Schools of Medicine, London
a.haines{at}ucl.ac.uk
DOES EUROPE NEED THE WHO?
(Does the WHO have a role in Europe? There is more to
Europe than you
might think)
http://www.bmj.com/cgi/content/full/316/7142/1402
In 1988 the future role of the WHO in Europe was in
doubt. It was
inconceivable that it would have to provide emergency relief
programmes in
war zones in Europe, malaria had long been eradicated and
non-communicable
diseases were viewed as a matter for individual countries.
Ten years
later, says Martin McKee from the European Centre on Health of
Societies in
Transition, although the geography remains the same, the role for
the WHO
has completely altered.
The author notes in this week's BMJ that many people do not
realise that
the European region of WHO includes the entire former Soviet
Union, with
member states such as Tajikistan, on the Afghan border and
Turkmenistan,
bordering Iran. As well as continuing to support war torn
countries, the
WHO has a huge amount of work to do to help countries address
discrepancies
in life expectancy between the regions (a 15 year old Icelandic
boy can
expect to live another 63 years whereas his Russian counterpart
is only
likely to have another 44 years). The WHO can also become a
source of
tried and tested knowledge for countries as they reform their
healthcare
systems and provide a useful framework for implementing change.
Finally the historical role of WHO as guardian of
international public
health should not be forgotten as diseases such as diphtheria and
malaria
have reappeared in areas from which they had been virtually
eliminated,
whilst cases of tuberculosis, AIDS and syphilis are increasing
dramatically
in the former Soviet Union.
Contact:
Professor Martin McKee, Professor of European Public Health,
European
Centre on Health of Societies in Transition (ECOHOST), London
School of
Hygiene and Tropical Medicine, London
m.mckee{at}lshtm.ac.uk
For further information on ECOHOST:
http://www.lshtm.ac.uk/other/ecohost/
PAEDIATRICIANS NEED GOOD WORKING KNOWLEDGE OF
TROPICAL INFECTIONS
(Prospective, hospital based study of fever in children in the
United
Kingdom who had recently spent time in the tropics)
http://www.bmj.com/cgi/content/full/316/7142/1425
In a year long study of children with tropical infections
admitted to
Northwick Park Hospital, Dr John Klein and Dr Guy Millman
found that there
is a relatively high incidence of potentially fatal tropical
infections in
children who are referred to hospital. Their study is
published in this
week's BMJ.
In most cases of infection the children were of former
immigrants who had
visited their country of origin, with south Asia being the most
common
destination. The absence of white children from admissions
might suggest
that they are less likely to go on holiday to exotic holiday
locations.
The authors were struck by the poor understanding of the health
risks
associated with travel, which was particularly evident in the
under-use of
antimalarial prophylaxis.
Klein and Millman conclude that paediatricians in the UK need
a good
working knowledge of life threatening tropical conditions as
access to
specialists in tropical medicine is limited.
Contact:
Dr John Klein,Lecturer in Micorbiology, UMDS of Guy's and St
Thomas, Guy's
Hospital, St Thomas Street, London
johnlklein{at}email.msn.com
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(contact Jill Shepherd;jshepher{at}bma.org.uk)
and from
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Advancement of Science (http://www.eurekalert.org)
Please remember to mention the BMJ as source when publicising an article
and to inform your readers that they can read its full text on the
journal's web site (http://www.bmj.com).
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